Provider Demographics
NPI:1124853775
Name:COMMUNITYCARE GOVERNMENT PROGRAMS, INC., D/B/A COMMUNITYCARE CHOICE, I
Entity type:Organization
Organization Name:COMMUNITYCARE GOVERNMENT PROGRAMS, INC., D/B/A COMMUNITYCARE CHOICE, I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-594-6529
Mailing Address - Street 1:2 W 2ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-3121
Mailing Address - Country:US
Mailing Address - Phone:918-594-5295
Mailing Address - Fax:
Practice Address - Street 1:2 W 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-3121
Practice Address - Country:US
Practice Address - Phone:918-594-5295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization